Patients Must Push Back

Several weeks ago I attended a very thought-provoking forum on “Healing Health Care: Curing the System of Overuse, Underuse and Misuse.” It was organized by one of my favorite groups, the Universal Health Care Foundation of Connecticut. I had written about a previous forum on my other blog, WebHealthWriter.com. However, I decided this blog was a much better fit for this topic. Because, although it was never explicitly mentioned, all issues in this health care mess tie directly to you, the patient, the health seeker.

We Wouldn’t Want It

The forum was headlined by Shannon Brownlee, Senior Vice President of the Lown Institute, and author/expert on the topic of overuse of medicine. It may be hard to comprehend exactly what it means to have too much medicine, so Brownlee summed it up nicely by noting that patients often receive medical care “that they don’t want, or wouldn’t want if they understood the trade-offs.” In short, we do what the doctor says, often without question. If we really understood the way the body heals – often simply through rest and good nutrition – then we wouldn’t even seek medical treatment for many of our ailments, or we would question more vehemently the need for tests and procedures. If you realized that having a test could greatly increase your risk for cancer while not actually giving you a definitive answer about your condition, would you do it? According to Brownlee, 1/3 of CT scans are unnecessary and lead to cancer. Yet, many of us would not question or resist if our doctor recommended such a scan.

More Is Not Better

Culturally we have grown to want some form of treatment or solution from our physicians. No one wants their health care providers to say, “you just need more rest” or “have you tried eating more fruits and vegetables?” We want them to do something for us. This is most evident in the situation we face with antibiotic-resistant bacteria. It came after years of overprescribed antibiotics, teamed with patients who were misusing them (i.e. taking them for viral infections that aren’t helped by the drugs or stopping their use too soon). In spite of much press around this issue, a recent Wall Street Journal article referencing the rise of drugstore medical clinics mentioned a mother who after receiving word that her child’s test for strep throat was negative said, “Would you consider maybe starting her on something?” This culturally ingrained belief that we must take a pill or have a procedure to be well is at least partially to blame for the fact that the pharmaceutical and medical device industries are so highly rewarded in our current medical system.

More than Money

Although the money surrounding this issue is overwhelming, with Brownlee comparing the drag on the US economy to the defense spending crash of the Soviet Union, the bigger issue is the pain and trauma inflicted on patients. After a string of statistics on widely overused medical treatments such as stents, Brownlee concluded, “it’s not the money that matters, it’s the wasted lives.” As many as 10-30% of cardiac catheterizations are unnecessary, and put patients and their families through a tremendous amount of risk, pain and worry. That surely trumps the estimated $20,000 per procedure they bring in to a hospital, right?

Banishing Certainty

After all the sobering news delivered by Brownlee, Connecticut physician Stephen Smith offered up his insight on the problem and the potential solution. He agreed that in our current health care system the more your do the more you make. But, he made it clear that this is not typically an issue of health care providers’ greed – a point in which I highly agree. Most medical providers are fully dedicated to helping their patients and making a profit is not their primary motive. In fact, as another panelist, Pamela Delerme (Certified Nurse-Midwife) mentioned, most providers don’t even know the costs of tests or procedures or how they are ultimately being reimbursed. They order treatments based on a drive for answers. Yet, as Smith concluded, that is one of the biggest problems in medicine – our need for certainty. We believe that we have to know beyond a shadow of a doubt what is happening medically. And, we will spend every ounce of energy, time and money to get answers, oftentimes when those answers won’t actually benefit our well-being.

Be a “Bad Patient”

Dr. Smith is an advocate for patient empowerment and involvement. He works with the Good Stewardship Project and the Choosing Wisely campaign which focus on encouraging patients and physicians to collaborate in an effort to ensure the safest, highest quality care is provided. One of the major pieces of this effort is for patients to ask questions and become active participants in their care. In short, patients have to get comfortable about bucking the system. As an audience member, and nurse, noted at the end of the forum, this often means feeling like a “bad patient.” I myself have been there. Once after complying with numerous expensive tests, I questioned my doctor as to why she felt I must repeat a very inconvenient and embarrassing test that had already indicated my kidneys were functioning at 100%. Her response, “boy you are a difficult patient.” I initially felt terrible guilt over being “difficult.” But, once my more rational sense kicked in, I’m proud to say I no longer see that doctor.

Words of Wisdom

Throughout the forum there were many points and statements that struck me as worth sharing including the following from Shannon Brownlee:

Our system needs more than reform it needs reformation, “radical transformative change.”

“We underuse time.”

Large hospitals are not better at quality. There is a great risk these institutions will become “too big to fail” as our banks have.

“Never whisper in the presence of wrong.” – a quote from Dr. Bernard Lown.

The forum was opened by UHCF president, Frances Padilla, and one of her statements was perhaps one of the most powerful, “change is hard, particularly when it threatens entrenched interests.” As patients we must recognize that there are many levels of interest in our care well beyond our doctor’s office. There is a great deal of money being made by outside forces, and as Brownlee pointed out, the health care lobbyists account for the largest source of money for Congress. In short, your care is big business, so just as you would shop for sales and quality in terms of your other household needs, you must do the same with your health care. Physicians are our teammates, but they are only one piece of a very challenging health care environment. To help them help you, you must be an active participant by questioning everything. You must push back.